Why creating a positive safety culture is a critical part of the Patient Safety Incident Response Framework (PSIRF)

Across England, NHS service providers have been working through the Patient Safety Incident Response Framework since it was published a year ago in preparation for the transition to a new approach in autumn 2023.

In this blog, Nathalie Delaney, Senior Programme Manager at the West of England AHSN, explores why understanding and creating a positive safety culture is such a critical part of the approach.

Patient Safety Collaboratives have been commissioned to support the implementation of the Patient Safety Incident Response Framework (PSIRF), working with their local integrated care systems (ICSs) and integrated care boards (ICBs), as well as NHS England regional teams.

One of the changes in approach through PSIRF includes a greater focus on taking a whole-system approach to exploring not only when things go wrong, but also how everyday work happens. Understanding and creating a positive safety culture is a vital part of this.

The new practical guide published by NHS England in association with the AHSN Network aims to support this. Improving Patient Safety Culture: a practical guide was developed out of Patient Safety Collaborative’s experience in exploring safety culture through various programmes.

Why is improving safety culture so important?

Again and again, investigations into where things go wrong in the NHS give recommendations to improve safety culture. But despite this, and lots of hard work from people across the health and care system, we sadly see the same issues and recommendations recurring.

This suggests that our approach isn’t working, and so this new practical guidance aims to give a clear definition of what safety culture is so that we can all work towards a shared understanding.

How does PSIRF fit into this?

PSIRF is a framework that sets out a new approach that not only looks at the systems and culture within which things happen but also gives a greater emphasis than before to compassionate engagement with those affected by an incident. This aligns with other recent guidance, such as the Being Fair report from NHS Resolution.

Is this about individual, team or organisational culture?

All of the above! But perhaps organisational culture is the most critical factor.

I often refer to the work of Mary Dixon-Woods describing a shift from comfort-seeking to problem-sensing cultures when talking about organisational culture, as that is the shift in mindset at an organisational level.

All of this is about learning and making sure that we put this learning into practice by developing learning systems.

How are Patient Safety Collaboratives supporting PSIRF and improving safety culture?

We’ve got strong connections with organisations across the system built up through our years of working on patient safety improvement together in a collaborative way. This means that within each of the 15 Patient Safety Collaboratives (each hosted by its local AHSN), we’ve got local networks and relationships in place.

Many areas are setting up collaborative events on a regional footprint or have held launch events to bring everyone together. Some meetings have been virtual, and we have been fortunate enough to meet face to face, which is exciting because there’s real power in getting people together in person to learn and share from each other.

That’s what we love doing in the Patient Safety Collaboratives, and what is needed to create learning systems to deliver improvements in safety that stick.

Find out more about our work and impact improving patient safety in the West of England.


Posted on September 4, 2023 by Nathalie Delaney, Senior Programme Manager at the West of England AHSN

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